Risk-bering arrangements between health plans, hospitals, medical groups and other health care organizations will be documented and evaluated for a sample of medical groups, hospital systems, and health plans/HMOs in Washington, Oregon, and California Risk-bearing arrangements refer to payment methods used by plans with medical groups (full risk capitation, professional services capitation for primary care plus specialty services, primary care capitation, fee-for-service plus a withhold) and other risk/reward structures used by plans (bonuses for surpluses in the "risk pool" for hospital, ancillary, an referral services). These arrangement will be evaluated on the basis of their impacts on health care costs and the efficiency and equity with which the risks are distributed. Alterative capital financing sources for the entities (hospitals, health plans, medical groups) developing integrated health systems will be evaluated: common stock (equity), private equity, private placement of debt, bank loans, public issuance of long term debt, short term debt, retained earnings, and venture capital. Alternative capital sources will be evaluated with respect to their risks, required returns, transaction costs, differential regulatory or other barriers, and the extent to which they contribute to the financial capacity of the entities in building integrated health systems. The principal method is case study, based on interviews within each entity (CEO, legal counsel, chief financial and managed care officers, clinical leadership), systematic document review (of financial statements, pro formas, special reports) and analysis of selected secondary data (equity returns on CRSP tapes). The deliverables from the organizational case studies will include a series of policy papers, a case study monograph for graduate and executive education, and a series of presentations to the participating organizations, emphasizing efficiency and equity implications of alternative risk-bearing and capital financing structures.